Provider Demographics
NPI:1215058698
Name:ANDERSON, BEVERLY JEAN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JEAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CLOISTER CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2207
Mailing Address - Country:US
Mailing Address - Phone:919-408-3212
Mailing Address - Fax:919-408-3306
Practice Address - Street 1:101 CLOISTER CT
Practice Address - Street 2:SUITE E
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2207
Practice Address - Country:US
Practice Address - Phone:919-408-3212
Practice Address - Fax:919-408-3306
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4552101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health